Herpes zoster (shingles), a painful and disabling disease, affects an estimated 1 million individuals in the United States annually and results in significant morbidity, lost productivity, and diminished quality of life. Herpes zoster constitutes the reactivation of varicella-zoster virus (VZV), the same virus that causes chickenpox. After resolution of chickenpox, VZV remains dormant in dorsal root ganglia. Varicella-zoster–specific cell-mediated immunity wanes naturally with advancing age or earlier in the setting of an altered immune status, which can result in the reactivation of VZV as herpes zoster. The pain associated with the rash caused by herpes zoster is often described as burning, stabbing, itching, or aching. Postherpetic neuralgia, the most common complication of herpes zoster, occurs after the zoster rash has resolved, affecting up to a third of patients. Herpes zoster is associated with significant morbidity, especially in the elderly. Herpes zoster is both more common and more severe among older adults. In both acute herpes zoster and postherpetic neuralgia, pain is the primary cause of morbidity.
Evidence-based strategies for the management of herpes zoster and postherpetic neuralgia (PHN) include the use of antiviral agents in acute zoster and specific analgesics in PHN. Antiviral agents are effective in reducing the severity and duration of acute herpes zoster when given within 72 hours of rash onset, but they do not prevent PHN. Anticonvulsants, tricyclic antidepressants, opioids, and topical treatment modalities such as lidocaine-containing patches and capsaicin cream offer moderate pain relief to some patients with PHN, but they may be associated with adverse events that limit their use. Therefore, prevention of herpes zoster and PHN with prophylactic vaccination using the zoster virus vaccine is an effective strategy to reduce the morbidity of these conditions. Treatment modalities are available, however, that may shorten the duration of acute herpes zoster and alleviate the pain of PHN.
This review of the data from the Shingles Prevention Study (SPS) highlights the efficacy and safety of a high-titer live attenuated herpes zoster virus vaccine in preventing herpes zoster and postherpetic neuralgia (PHN) in adults aged 60 years or older. In the SPS, the vaccine reduced the burden of illness due to herpes zoster disease by 61.1% and the incidence of its most common and debilitating sequela, PHN, by 66.5%. In addition, vaccination was associated with a 51.3% reduction in the overall incidence of herpes zoster. Also, subjects in whom herpes zoster did develop had decreased pain and discomfort. The vaccine was safe in the SPS population, with little differentiation from the safety profile of placebo other than an increased risk for reactions at the injection site. Rates of serious adverse events, systemic adverse events, hospitalization, and death were low and similar to those observed in the group that received placebo.
